Medicaid and Medicare Savings Programs – 2018

Medicaid and Medicare Savings Programs - 2018

Public benefit programs (such as Medicaid) use the Federal Poverty Level (FPL) guidelines to determine who qualifies for coverage. The table below includes the current income and resource limits someone needs to meet to qualify for Medicaid and Medicare Savings Programs in 2018.

For more details, see Medicaid and Medicare Savings Programs (MSP): Help with Medical Expenses.

Category Description 2018 Monthly Income Limit 2018 Resource Limit
Healthy Horizons
(QMB Plus)
Full Medicaid coverage for
individuals age 65 and older and
persons with permanent
disabilities
$1,025 single
$1,374 married
$2,000 single
$3,000 married
Qualified Medicare
Beneficiary (QMB)
Helps Medicare beneficiaries
with Part A and B cost-sharing
as well as the Part B premium
$1,025 single
$1,374 married
$7,390 single
$11,090 married
Specified Low-Income
Medicare Beneficiary
(SLMB)
Helps Medicare beneficiaries
pay the Part B premium
$1,226 single
$1,644 married
7,390 single
$11,090 married
Qualified Individual
(QI-1)
Helps Medicare beneficiaries
pay the Part B premium
$1,377 single
$1,847 married
$7,390 single
$11,090 married

            Table 1. Medicaid and Medicare Savings Programs – Eligibility

 

Medicaid and Medicare Savings Programs – Definition of Income

For eligibility purposes, all income that one receives from any source is counted. This may include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Make note, when only one spouse of a married couple is applying for Medicaid, the income of the applicant’s spouse is not counted, only the income of the applicant.

Medicaid and Medicare Savings Programs – Definition of Resources

Countable resources include stocks, bonds, investments, and savings and checking accounts. However, for Medicaid eligibility, there are many resources that are considered exempt (non-countable). For instance, Pennsylvania allows an extra $6,000 exemption, which is in addition to the resources limits listed above. Other exemptions include personal belongings, household items, a vehicle, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $560,000. One exception for the home to be considered exempt remains; single applicants who do not live in their primary home, but communicate an “intent” to return.

It’s important to be aware that Pennsylvania has a 5-year Medicaid Look-Back Period. This is a period of 5 years in which Medicaid checks to ensure no assets were sold or given away under fair market value in order to meet Medicaid’s asset limit. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.

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